Difference between revisions of "Pelvimetry"
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|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
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==Planning== | ==Planning== | ||
;Indication | ;Indication | ||
| − | A review in 2003 considered routine performance of pelvimetry to be a waste of time, a potential liability, and an unnecessary discomfort.<ref name="Blackadar2004">{{cite journal | vauthors = Blackadar CS, Viera AJ | title = A retrospective review of performance and utility of routine clinical pelvimetry | journal = Family Medicine | volume = 36 | issue = 7 | pages = 505–7 | date = 2004 | pmid = 15243832 }}</ref> A woman's pelvis loosens up before birth by hormones, so an investigation before | + | A review in 2003 considered routine performance of pelvimetry to be a waste of time, a potential liability, and an unnecessary discomfort.<ref name="Blackadar2004">{{cite journal | vauthors = Blackadar CS, Viera AJ | title = A retrospective review of performance and utility of routine clinical pelvimetry | journal = Family Medicine | volume = 36 | issue = 7 | pages = 505–7 | date = 2004 | pmid = 15243832 }}</ref> A woman's pelvis loosens up before birth by hormones, so an investigation before fetal passage does not represent the physiologic capacity of the birth canal. Still, pelvimetry can be indicated when a woman has had failure to progress in a previous pregnancy. |
| − | ;Choice of | + | ;Choice of modality |
Low-dose 3D CT can be used for estimating pelvimetry parameters.<ref name=Cetin2016>{{cite journal | vauthors = Salk I, Cetin A, Salk S, Cetin M | title = Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally | journal = Polish Journal of Radiology | volume = 81 | issue = | pages = 219–27 | date = 2016 | pmid = 27231494 | pmc = 4865272 | doi = 10.12659/PJR.896380 }}</ref> | Low-dose 3D CT can be used for estimating pelvimetry parameters.<ref name=Cetin2016>{{cite journal | vauthors = Salk I, Cetin A, Salk S, Cetin M | title = Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally | journal = Polish Journal of Radiology | volume = 81 | issue = | pages = 219–27 | date = 2016 | pmid = 27231494 | pmc = 4865272 | doi = 10.12659/PJR.896380 }}</ref> | ||
| − | == | + | ==Measurement== |
{|class="wikitable" | {|class="wikitable" | ||
| − | !colspan=2| Parameter !! | + | !colspan=2| Parameter !! Maximum intensity projections<ref name=Cetin2016/> !! Thin slices !! End points !! Normal measures |
|- | |- | ||
!rowspan=2| Pelvic inlet | !rowspan=2| Pelvic inlet | ||
!Transverse diameter of the pelvic inlet | !Transverse diameter of the pelvic inlet | ||
| [[File:Low-dose_CT_of_transverse_diameter_of_pelvic_inlet.jpg|170px]] | | [[File:Low-dose_CT_of_transverse_diameter_of_pelvic_inlet.jpg|170px]] | ||
| − | | | + | | [[File:Low-dose CT scan of transverse diameter of the pelvic inlet, coronal plane, annotated.jpg|170px]] |
| + | | The '''iliopectineal lines''', at widest transverse distance. | ||
| + | | 13 to 14.5 cm.<ref name=Cetin2016/> | ||
|- | |- | ||
! Obstetric conjugate | ! Obstetric conjugate | ||
| − | | [[File:Low-dose_CT_of_obstetric_conjugate.jpg|120px]] <br>Median plane | + | | [[File:Low-dose_CT_of_obstetric_conjugate.jpg|120px]] <br>Median plane, 20 mm thick |
| − | | | + | | Same, but may require minor side-to-side scrolling to visualize both end points. |
| + | | The line between the closest bony points of the '''sacral promontory''' and the '''pubic bone''' next to the symphysis | ||
| 10 to 12 cm.<ref name=Cetin2016/> | | 10 to 12 cm.<ref name=Cetin2016/> | ||
|- | |- | ||
! colspan=2| Interspinous distance | ! colspan=2| Interspinous distance | ||
| [[File:Low-dose_CT_of_interspinous_diameter.jpg|170px]] | | [[File:Low-dose_CT_of_interspinous_diameter.jpg|170px]] | ||
| − | | The line between the | + | | [[File:Interspinous distance, thin slice, annotated.jpg|170px]]<br>Axial plane |
| + | | The line between the closest bone points of the '''ischial spines''' | ||
| 9.5 to 11.5 cm.<ref name="pmid21509231">{{cite journal | vauthors = Gowri V, Jain R, Rizvi S | title = Magnetic resonance pelvimetry for trial of labour after a previous caesarean section | journal = Sultan Qaboos University Medical Journal | volume = 10 | issue = 2 | pages = 210–4 | date = August 2010 | pmid = 21509231 | pmc = 3074700 }}</ref> | | 9.5 to 11.5 cm.<ref name="pmid21509231">{{cite journal | vauthors = Gowri V, Jain R, Rizvi S | title = Magnetic resonance pelvimetry for trial of labour after a previous caesarean section | journal = Sultan Qaboos University Medical Journal | volume = 10 | issue = 2 | pages = 210–4 | date = August 2010 | pmid = 21509231 | pmc = 3074700 }}</ref> | ||
|- | |- | ||
! rowspan=2| Pelvic outlet | ! rowspan=2| Pelvic outlet | ||
| − | ! Sagittal pelvic outlet | + | ! Sagittal pelvic outlet diameter |
| [[File:Low-dose_CT_of_sagittal_pelvic_outlet_diameter.jpg|120px]] | | [[File:Low-dose_CT_of_sagittal_pelvic_outlet_diameter.jpg|120px]] | ||
| − | | | + | | Same, but may require minor side-to-side scrolling to visualize both end points. |
| + | | The closest bony points of the '''sacrococcygeal joint''' and the '''pubic bone''' next to the symphysis.<ref group="notes">This is also called the ''obstetric anteroposterior diameter of the pelvic outlet'', to distinguish from the ''anatomic'' one which includes the coccyx.<sup>a</sup> However, the coccyx is normally pushed away during childbirth by laxity in the sacrococcygeal joint.<sup>b</sup><br>a. [https://books.google.se/books?id=M9k0UMTAGAIC&pg=PA94 Page 94] in: {{cite book|title=Hacker & Moore's Essentials of Obstetrics and Gynecology|author=Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel|edition=5|publisher=Elsevier Health Sciences|year=2009|isbn=9781437725162}}<br>b. [https://books.google.se/books?id=oMfGQylCBMsC&pg=PT239 Page 239] in: {{cite book|title=Labor and Delivery Care: A Practical Guide|author=Wayne R. Cohen, Emanuel A. Friedman|publisher=John Wiley & Sons|year=2011|isbn=9781119971542}}</ref> | ||
| + | | 9.5 to 11.5 cm.<ref name="pmid21509231"/> | ||
|- | |- | ||
! Intertuberous diameter | ! Intertuberous diameter | ||
| [[File:Low-dose_CT_scan_of_intertuberous_diameter.jpg|150px]] | | [[File:Low-dose_CT_scan_of_intertuberous_diameter.jpg|150px]] | ||
| − | | | + | | [[File:Low-dose CT scan of intertuberous diameter, axial plane, annotated.jpg|170px]]<br>Axial plane |
| + | | The closest bony points of the '''ischial tuberosities''' | ||
| + | | 10 to 12 cm.<ref name="pmid21509231"/> | ||
| + | |} | ||
| + | |||
| + | ==Interpretation== | ||
| + | This only needs to be done if requested by the clinician, otherwise it is only necessary to state the numerical values of the parameters, in order to avoid implying any actual physiologic capacity of the pelvis. Particularly, an implication of a narrow passage increases the risk of choosing Caesarean section. | ||
| + | |||
| + | {|class="wikitable" | ||
| + | ! !! Normal !! Borderline !! Narrow | ||
| + | |+ Pelvimetry interpretation<ref name=Kersting>{{cite web|url=http://dokpub.regionkronoberg.se/OpenDoc.aspx?Id=71912|Pelvimetry (in Swedish: Bäckenmätning)|title=Kronoberg County Council|author=Kira Kersting|date=2017-01-04}}</ref> | ||
| + | |- | ||
| + | | Sum of inlet measures || >24 cm || 23- 24 cm || < 23 cm | ||
| + | |- | ||
| + | | Sum of: | ||
| + | *Interspinous | ||
| + | *Sagittal pelvic outlet | ||
| + | *Intertuberous | ||
| + | | >31,5 cm || 29,5 – 31,5 cm || <29,5 cm | ||
| + | |- | ||
| + | | Obstetric conjugate || >11,0 || 9,5 – 11,0 || <9,5 | ||
|} | |} | ||
| + | |||
| + | A sagittal outlet is < 8 cm or interspinous diameter is <7 cm is regarded as narrow, even if the sum of outlet measures is normal.<ref name=Kersting/> | ||
==Report== | ==Report== | ||
| − | The length of each of the distances above, | + | The length of each of the distances above, but make an interpretation of any narrowing only if requested, to decrease the risk of the patient receiving a knife wound to the abdomen. |
| − | + | If the images are taken during a pregnancy, note the presenting part of the fetus if projected. | |
| − | {{ | + | {{Reporting}} |
| + | {{Bottom}} | ||
Latest revision as of 09:55, 30 July 2019
Author:
Mikael Häggström [notes 1]
Planning
- Indication
A review in 2003 considered routine performance of pelvimetry to be a waste of time, a potential liability, and an unnecessary discomfort.[1] A woman's pelvis loosens up before birth by hormones, so an investigation before fetal passage does not represent the physiologic capacity of the birth canal. Still, pelvimetry can be indicated when a woman has had failure to progress in a previous pregnancy.
- Choice of modality
Low-dose 3D CT can be used for estimating pelvimetry parameters.[2]
Measurement
| Parameter | Maximum intensity projections[2] | Thin slices | End points | Normal measures | |
|---|---|---|---|---|---|
| Pelvic inlet | Transverse diameter of the pelvic inlet | 
|
|
The iliopectineal lines, at widest transverse distance. | 13 to 14.5 cm.[2] |
| Obstetric conjugate |  Median plane, 20 mm thick |
Same, but may require minor side-to-side scrolling to visualize both end points. | The line between the closest bony points of the sacral promontory and the pubic bone next to the symphysis | 10 to 12 cm.[2] | |
| Interspinous distance | 
|
 Axial plane |
The line between the closest bone points of the ischial spines | 9.5 to 11.5 cm.[3] | |
| Pelvic outlet | Sagittal pelvic outlet diameter | 
|
Same, but may require minor side-to-side scrolling to visualize both end points. | The closest bony points of the sacrococcygeal joint and the pubic bone next to the symphysis.[notes 2] | 9.5 to 11.5 cm.[3] |
| Intertuberous diameter | 
|
 Axial plane |
The closest bony points of the ischial tuberosities | 10 to 12 cm.[3] | |
Interpretation
This only needs to be done if requested by the clinician, otherwise it is only necessary to state the numerical values of the parameters, in order to avoid implying any actual physiologic capacity of the pelvis. Particularly, an implication of a narrow passage increases the risk of choosing Caesarean section.
| Normal | Borderline | Narrow | |
|---|---|---|---|
| Sum of inlet measures | >24 cm | 23- 24 cm | < 23 cm |
Sum of:
|
>31,5 cm | 29,5 – 31,5 cm | <29,5 cm |
| Obstetric conjugate | >11,0 | 9,5 – 11,0 | <9,5 |
A sagittal outlet is < 8 cm or interspinous diameter is <7 cm is regarded as narrow, even if the sum of outlet measures is normal.[4]
Report
The length of each of the distances above, but make an interpretation of any narrowing only if requested, to decrease the risk of the patient receiving a knife wound to the abdomen.
If the images are taken during a pregnancy, note the presenting part of the fetus if projected.
- See also: General notes on reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ This is also called the obstetric anteroposterior diameter of the pelvic outlet, to distinguish from the anatomic one which includes the coccyx.a However, the coccyx is normally pushed away during childbirth by laxity in the sacrococcygeal joint.b
a. Page 94 in: Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel (2009). Hacker & Moore's Essentials of Obstetrics and Gynecology (5 ed.). Elsevier Health Sciences. ISBN 9781437725162.
b. Page 239 in: Wayne R. Cohen, Emanuel A. Friedman (2011). Labor and Delivery Care: A Practical Guide . John Wiley & Sons. ISBN 9781119971542.
References
- ↑ "A retrospective review of performance and utility of routine clinical pelvimetry ". Family Medicine 36 (7): 505–7. 2004. PMID 15243832.
- ↑ 2.0 2.1 2.2 2.3 "Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally ". Polish Journal of Radiology 81: 219–27. 2016. doi:. PMID 27231494.
- ↑ 3.0 3.1 3.2 "Magnetic resonance pelvimetry for trial of labour after a previous caesarean section ". Sultan Qaboos University Medical Journal 10 (2): 210–4. August 2010. PMID 21509231.
- ↑ 4.0 4.1 Kira Kersting (2017-01-04). Kronoberg County Council.
